UA and Hematuria - Exam 2

Question 1

What type of sample does UA need to be?

Answer 1

clean catch

Question 2

What color is normal urine? What does cloudy urine represent?

Answer 2

norma: “straw yellow” that is translucent

cloudy: pyuria, bacteriuria and diet

Question 3

What does ammonia odor indicate? fishy?

Answer 3

ammonia: bladder retention, long standing urine

fishy: UTI

Question 4

What does a “strong” urine odor indiate? musty?

Answer 4

strong: concentrated urine

musty: PKU

Question 5

What is the normal urine pH range? What is the average?

Answer 5

normal: 4.5-8

average: 5-6

Question 6

What factors can make urine become more acidic? alkaline? What else can make the urine pH change?

Answer 6

Acidic - High-protein diet, cranberries
Alkaline - Vegetarian diet, low-carb diet, citrus

metabolic errors such as urinary stone dz can cause the urine pH to change

Question 7

With regards to RBC, what can make the urine dipstick test positive? How do you tell the difference?

Answer 7

+ if intact RBCs, hemoglobin, or myoglobin in the urine

need to order microscopy to confirm the presence of RBCs

Question 8

What are some common false positives for heme? false negatives?

Answer 8

Menstrual blood contamination
Semen in urine
Vigorous exercise
Concentrated urine (normal - 1,000 RBCs/mL in urine)

High ascorbic acid levels in urine

Question 9

What is leukocyte esterase? If it pops positive on urine dipstick, what does it indicate?

Answer 9

Enzyme produced by WBCs - indicates presence of WBCs

suggests UTI but NOT diagnostic!!

Question 10

What are some common false negatives for leukocyte esterase? false positives?

Answer 10

high specific gravity
glycosuria
urobilinogen
medications (rifampin, phenazopyridine)
ascorbic acid

false positive:
contamination

Question 11

will normal urine have nitrates? What do nitrates suggest?

Answer 11

normal urine does NOT have nitrates

presence of gram - bacteria

Question 12

What are some common false negatives for nitrites?

Answer 12

non-nitrite producing organisms, frequent urination, dilute or acidic urine, urobilinogen

Question 13

What does bilirubin/urobilinogen make you think?

Answer 13

think liver

Question 14

Urobilinogen: bilirubin metabolism by _______. What would make it increase? decrease?

Answer 14

gut bacteria

Increased - hemolysis, hepatocellular disease
Decreased - biliary obstruction, altered gut flora

Question 15

What would make Bilirubin / Urobilinogen false positive? false negative?

Answer 15

False positive - phenazopyridine
False negative - ascorbic acid

Question 16

What does glucose in the urine make you think? What would cause a false negative?

Answer 16

DM or SGLT-2 use

false negative: ketones, ascorbic acid

Question 17

Are ketones normally found in urine? What are some causes? What would make a false positive?

Answer 17

ketones are NOT normally found in the urine

causes: post exercise, fasting, pregnancy

false positive: dehydration, levodopa metabolites

Question 18

protein on urine dip needs to be _____ or greater to be detected. Test is sensitive for _____ only

Answer 18

10mg/dL

albumin only

Question 19

What would make a urine protein appear to be false positive? false negative?

Answer 19

False positive - WBCs, epithelial cells, bacteria

False negative - dilute urine, lower proteinuria levels

Question 20

What does specific gravity of urine tell you?

Answer 20

weight of urine compared to weight of water

estimates urine concentration, measures number and size of particles in urine

Question 21

Describe the process of urine microscopy

Answer 21

Urine is centrifuged to cause sediment to precipitate.This sediment is then resuspended in a small volume of urine and put onto a glass slide for analysis

Question 22

What is significant for RBCs on urine microscopy?

Answer 22

> 5 RBC per HPF on a single occasion OR >3 RBC per HPF on multiple occasions

Question 23

What are some causes of RBCs in urine microscopy? What does the shape tell you?

Answer 23

glomerular damage, tumors, trauma, nephrolithiasis, infection, inflammation, nephrotoxins, AKI

Dysmorphic - glomerular disease
Round (normal) - urinary tract epithelial disease or damage

Question 24

What are RBC casts? When would you commonly see them?

Answer 24

Mucoprotein with RBCs inside or stuck together

glomerulonephritis, vasculitis

Question 25

When are WBCs in urine microscopy significant? What do they indicate?

Answer 25

> 5 WBC per HPF - significant Indicate injury to urinary tract Infection, stones, strictures, cancer, glomerulonephritis, interstitial cystitis, AKI

Question 26

What do WBC casts in urine microscopy indicate?

Answer 26

WBCs inside or stuck together by mucoprotein Indicate inflammation of the kidney **Only form in the kidney** Acute pyelonephritis, interstitial nephritis

Question 27

What does a single organism type of bacteria indicate? multiple types of organisms?

Answer 27

Single organism = more likely to be infection Multiple organisms = more likely to be contamination

Question 28

If you suspect an UTI, what do you need to do next? What is important to note about catheterized/suprapubic tap specimens?

Answer 28

culture Catheterized or suprapubic tap - any bacteria = significant

Question 29

What is the MC species of yeast to be found in urine?

Answer 29

candida albicans

Question 30

What does tubular epithelial cells in urine indicate? What will you find if lipiduria occurs?

Answer 30

Nephrotic syndrome or any tubular degeneration → increased shedding endogenous fat droplets fill these cells “oval fat bodies,” “Maltese crosses,” or “grape clusters”

Question 31

What do squamous epithelial in the urine suggest? What does transitional epithelial suggest?

Answer 31

Skin surface or outer urethra Suggest urine contamination if high numbers, concerning for neoplasms

Question 32

What do hyaline casts indicate? granular casts? waxy casts?

Answer 32

hyaline: common and normal granular: renal damage waxy: CKD

Question 33

What does a waxy cast look like?

Answer 33

Wide, bland-looking casts Shaped like wide, dilated nephrons

Question 34

What do you need to do next if there is persistent hematuria in the absence of infection?

Answer 34

The upper urinary tract should be imaged, and cystoscopy should be performed

Question 35

What OTC medication can make the urine red (false hematuria)? What do you need to do next?

Answer 35

azo Examine urine under a microscope to confirm and to look for microscopic hematuria

Question 36

The presence of WBC and/or Leukocyte Esterase and/or Nitrites indicates possible _______ and may be confirmed by _______ and treated appropriately

Answer 36

infection urine culture (if indicated)

Question 37

Proteinuria and red cell casts indicate ________. What do you need to do next?

Answer 37

renal origin labs and renal imaging +/- nephro consult

Question 38

Urinary cytology and/or cystoscopy with biopsy can assist in the dx of ______

Answer 38

bladder neoplasm

Question 39

_______ and ______ have generally replaced IV urography when imaging the UPPER tracts for sources of hematuria. Which one is the imaging of choice?

Answer 39

**CT urography (imaging modality of choice) MR

Question 40

Describe the role of US in hematuria.

Answer 40

The role of US of the urinary tract for hematuria is unclear. Although it may provide adequate information for the kidney, its sensitivity in detecting ureteral disease is lower. In addition, its higher degree of operator dependence may further confound its utility.

Question 41

When is IV pyelogram used?

Answer 41

An x ray of the urinary tract using contrast medium to visualize urine and possible blockage in the urinary tract

Question 42

When is cystoscopy commonly used?

Answer 42

To rule out pathology of the LOWER urinary tract, especially when the pt is actively bleeding to see where the source of the blood is coming from

Question 43

if no obvious reasons for bleeding is found, when do you need to repeat urinary cytology? cystoscopy and upper tract imaging?

Answer 43

Urinary cytology can be repeated in 3–6 months Cystoscopy and upper tract imaging can be repeated after a year

Question 44

When do you need to refer for hematuria?

Answer 44

If no infection is present, persistent/recurrent hematuria requires evaluation with urology or nephrology as appropriate